ABSTRACT
Hypokalemic periodic paralysis (HypoPP) type 1 is an autosomal dominant disease caused by mutations in the Ca(V)1.1 calcium channel encoded by the CACNA1S gene. Only seven mutations have been found since the discovery of the causative gene in 1994. We describe a patient with HypoPP who had a high serum potassium concentration after recovery from a recent paralysis, which complicated the correct diagnosis. This patient and other affected family members had a novel mutation, p.Arg900Gly, in the CACNA1S gene.
Subject(s)
Calcium Channels/genetics , Hypokalemic Periodic Paralysis/diagnosis , Hypokalemic Periodic Paralysis/genetics , Mutation/genetics , Adult , Aged , Calcium Channels, L-Type , Humans , Male , PedigreeABSTRACT
A 69-year-old male patient underwent subtotal esophagectomy for esophageal cancer under sevoflurane anesthesia combined with epidural analgesia. According to the protocol for the prevention of deep vein thrombosis (DVT) in our hospital, only an intermittent pneumatic compression device (IPC) and elastic stockings were perioperatively used for prophylaxis of DVT although D-dimer level was slightly increased to 1.2 microg x ml(-1). On the 2nd post-operative day, a venous ultrasound examination was performed, because D-dimer level was suddenly increased up to 41.5 microg x ml(-1) without any signs of thrombus in the atrium and pleural cavity. Since DVT was detected with the right lower limb, the use of an IPC was stopped and an inferior vena cava filter was inserted through the right jugular vein with a continuous administration of heparin. An aggressive search should be performed if DVT is suspected by any clinical signs including an increase in D-dimer level. We should also keep in mind the possibility of DVT even if an IPC and elastic stockings are perioperatively used.
Subject(s)
Intermittent Pneumatic Compression Devices , Venous Thrombosis/etiology , Aged , Esophageal Neoplasms/surgery , Fibrin Fibrinogen Degradation Products/analysis , Humans , Male , Postoperative Complications , Treatment Outcome , Venous Thrombosis/prevention & controlABSTRACT
BACKGROUND: We evaluated retrospectively the effectiveness of low dose colforsin daropate hydrochloride (CDH) in 12 patients undergoing off-pump coronary artery bypass grafting (CABG). METHODS: Low dose CDH was administered intravenously at a rate of 0.05-0.1 microg x kg(-1) x min(-1) from sternotomy to the end of coronary artery anastomosis. Hemodynamic measurements were made before infusion of CDH, and before, during, and after coronary artery anastomosis. RESULTS: Heart rate was significantly higher before, during and after the anastomosis compared with the value before the infusion of CDH. Heart rate was also significantly higher after the anastomosis compared with the value before the anastomosis. Systolic blood pressure, mean pulmonary pressure, right atrial pressure and pulmonary artery wedge pressure showed no significant changes after the start of infusion of CDH. Cardiac output was significantly higher before, during and after the anastomosis compared with the value before the infusion of CDH. Systemic vascular resistance was significantly lower before and during anastomosis compared with the value before the infusion of CDH. CONCLUSIONS: Infusion of low dose CDH prevents the elevations of mean pulmonary artery pressure, right atrial pressure and pulmonary artery wedge pressure without reducing systolic bood pressure during coronary artery anastomosis. Cardiac output was significantly increased, and SVR as well as PVR were significantly decreased after the infusion of CDH. In patients undergoing off-pump CABG, we recommend infusion of low dose colforsin daropate hydrochloride from sternotomy to the end of coronary artery anastomosis.
